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Closing the Knowledge Gap: New food allergy guidelines provide clarity to some otolaryngologists

by Bryn Nelson •

Infants

“In terms of introducing infants to foods, you have to take it all the way back to pregnancy,” said William Reisacher, MD, assistant professor of otorhinolaryngology and director of The Allergy Center within the department of otorhinolaryngology at Weill Cornell Medical College/New York-Presbyterian Hospital. “Mothers are concerned: If they have a family history of food allergies, should they be consuming certain foods during their pregnancy? Then what should they do in terms of breastfeeding? Is that beneficial at all? And then when do you actually introduce the foods? Do you test the child before you introduce the foods?”

Educating Patients and Parents

Educating Patients and Parents

Beyond getting physicians up to date with current research on food allergy, several otolaryngologists said the NIAID guidelines provide much-needed information and clarity for patients and the parents of children with allergies. “It streamlines how you can counsel your patients with food allergies,” said Elizabeth Mahoney, MD, an otolaryngologist at Boston University Medical Center.

The guidelines, she said, also serve as a reminder to physicians that they should be working with their patients on a food allergy action plan. “We should really be reviewing with them a) how to avoid foods and b) what to do if they have an accidental exposure,” she said.

Dr. Mahoney said mothers in her clinic frequently ask her whether they should avoid certain foods while pregnant or nursing. The guidelines’ new affirmation that they don’t need to restrict their diets to prevent allergies in their children may help her provide more definitive advice and comfort (Guideline 36).

Section 3.1 of the document, which details the natural history of food allergy in children, should likewise be reassuring to parents and caregivers, said Karen Calhoun, MD, an otolaryngologist at the Ohio State University Medical Center. Studies suggest that many of these allergies, including milk, egg, soy and wheat, will resolve within the first five to 10 years of life, with some important exceptions such as peanuts and tree nuts.

Other guidelines appear designed to avoid confusion among patients: namely, that no known medication can prevent a food allergy or food reaction (Guidelines 26 and 27) and that once an IgE-mediated food allergy has been documented, the best treatment is to avoid that food (Guideline 19). Doing so may require constant vigilance, however, and another guideline (Guideline 24) focuses on educating patients and caregivers about the importance of reading food labels to detect allergens. “Basically, they need help in becoming skilled ‘food detectives,’” Dr. Calhoun said.